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Metformin versus insulin in gestational diabetes mellitus: a meta-analysis of randomized clinical trials

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Abstract

Background

Metformin is widely used in treatment of type 2 diabetes. However, whether it is safe for use in pregnancy is controversial.

Methods

A search for relevant studies were performed using PubMed (1948–2014), Embase (1974–2014), the Web of knowledge (1950–2014), and the Cochrane database, included all randomized control trials published in English.

Results

Eight RCTs (1712 patients with gestational diabetes mellitus) were retrieved; of those 853 patients were given metformin, and 859 patients were given insulin. Our results showed that metformin does not increase risk of prematurity (RR = 1.26; 95 % CI [0.89, 1.79], P = 0.19). In addition, metformin can either decrease the total weight gain [MD = −1.49, 95 % CI (−2.66, −0.31), P = 0.01] or weight gain after randomization [MD = −1.23, 95 % CI (−1.75, −0.71), P < 0.00001]. No significant differences were observed in patients with pre-eclampsia [RR = 0.82, 95 % CI (0.56, 1.2), P = 0.32] or caesarean section [RR = 0.93, 95 % CI (0.75, 1.16), P = 0.53]. Use of metformin also significantly decreased the risk of neonatal hypoglycemia [RR = 0.58, 95 % CI (0.43, 0.78), P = 0.0003] and admission rates to neonatal intensive care units [RR = 0.74, 95 % CI (0.61, 0.89), P = 0.002]. No other adverse effects were observed, such as hyperbilirubinaemia [RR = 0.83, 95 % CI (0.64, 1.08), P = 0.16], large for gestational age [RR = 0.85, 95 % CI (0.68, 1.05), P = 0.14], small for gestational age [RR = 0.92, 95 % CI (0.61, 1.39), P = 0.69], macrosomia [RR = 0.75, 95 % CI (0.54, 1.03), P = 0.07] or respiratory distress syndrome [RR = 0.88, 95 % CI (0.55, 1.41), P = 0.6].

Conclusions

Metformin may be beneficial in treating gestational diabetes. However, even more studies are needed to provide more evidence for the future use of metformin.

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Author notes

    Authors and Affiliations

    1. Beijing Tian Tan Hospital, Capital Medical University, Beijing, China

      B. Zhu, X. G. Li, T. Liu & Z. G. Zhao

    2. Beijing Shijitan Hospital, Capital Medical University, Beijing, China

      L. Zhang

    3. Beijing Tongren Hospital, Capital Medical University, Beijing, China

      Y. Y. Fan

    4. The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China

      L. Wang

    5. Dong Fang Hospital-The Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China

      Y. S. Cao

    Authors
    1. B. Zhu
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    2. L. Zhang
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    4. L. Wang
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    5. X. G. Li
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    Correspondence to Z. G. Zhao.

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    The authors declare no competing financial interests.

    Funding

    This study was funded by National Natural Scientific Foundation of China [Grant number: 81402814].

    Additional information

    B. Zhu, L. Zhang contributed equally.

    Appendix

    Appendix

    See Table 2.

    Table 2 Diagnosis of gestational diabetes mellitus and inclusion criteria
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    Zhu, B., Zhang, L., Fan, Y.Y. et al. Metformin versus insulin in gestational diabetes mellitus: a meta-analysis of randomized clinical trials. Ir J Med Sci 185, 371–381 (2016). https://doi.org/10.1007/s11845-016-1414-x

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